Assessment of Coronary Artery Stenosis Severity and Location Quantitative Analysis of Transmural Perfusion Gradients by High-Resolution MRI Versus FFR

JACC-CARDIOVASCULAR IMAGING

卷:6

Article

Chiribiri, Amedeo^1,2,3  Hautvast, Gilion L. T. F.⁴  Lockie, Timothy^5,6  Schuster, Andreas^1,2,3,7,8  Bigalke, Boris^1,2,3  Olivotti, Luca^1,2,3  Redwood, Simon R.^5,6  Breeuwer, Marcel^9,10  Plein, Sven^1,2,3,11  Nagel, Eike^1,2,3 

[1] Kings Coll London British Heart Fdn Ctr Excellenc, Div Imaging Sci & Biomed Engn, Natl Inst Hlth Res Biomed Res Ctr, London SE1 7EH, England

[2] Guys & St Thomas NHS Fdn Trust, Wellcome Trust, London, England

[3] Guys & St Thomas NHS Fdn Trust, Engn & Phys Sci Res Council Med Engn Ctr, London, England

[4] Philips Grp Innovat Healthcare Incubators, Eindhoven, Netherlands

[5] St Thomas Hosp, Kings Coll London British Heart Fdn Ctr Excellenc, Div Cardiovasc, London, England

[6] St Thomas Hosp, Guys & St Thomas NHS Fdn Trust, Natl Inst Hlth Res Biomed Res Ctr, London, England

[7] Univ Gottingen, Dept Cardiol & Pulmonol, D-37073 Gottingen, Germany

[8] German Ctr Cardiovasc Res, DZHK, Gottingen, Germany

[9] Philips Healthcare, Imaging Syst MR, Best, Netherlands

[10] Eindhoven Univ Technol, NL-5600 MB Eindhoven, Netherlands

[11] Univ Leeds, Div Cardiovasc & Neuronal Remodeling, Leeds, W Yorkshire, England

关键词: adenosine;    coronary disease;    fractional flow reserve;    magnetic resonance imaging;    perfusion;   

DOI  :  10.1016/j.jcmg.2012.09.019

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to test the hypothesis that transmural perfusion gradients (TPG) on adenosine stress myocardial perfusion cardiac magnetic resonance (CMR) predict hemodynamically significant coronary artery disease (CAD) as defined by fractional flow reserve (FFR). BACKGROUND Myocardial ischemia affects the subendocardial layers of the left ventricular myocardium earlier and more severely than the outer layers, and the identification of TPG should be sensitive and specific for the diagnosis of CAD. Previous studies have shown that high spatial resolution myocardial perfusion CMR allows quantitation of TPG between the subendocardium and the subepicardium. METHODS Sixty-seven patients (53 men, age 61 +/- 9 years) underwent coronary angiography and high-resolution (1.2 x 1.2-mm in-plane) adenosine stress perfusion CMR at 3.0-1. TPG was calculated for 3 coronary territories. Visual analysis was performed to identify myocardial ischemia. FFR was measured in all vessels with >= 50% severity stenosis. FFR <0.8 was considered hemodynamically significant. In a training group of 30 patients, the optimal threshold of TPG to detect significant CAD was determined (Group 1). This threshold was then tested prospectively in the remaining 37 patients (Group 2). RESULTS In Group 1, a 20% TPG provided the best diagnostic threshold on both per-segment and per-patient analysis. Applied to Group 2, this threshold yielded a sensitivity of 0.78, specificity of 0.94, and area under the curve of 0.86 for the detection of CAD in a per-segment analysis and of 0.89, 0.83, and 0.86 in a per-patient analysis, respectively. TPG had a similar diagnostic accuracy to visual assessment. Linear regression analysis showed a relationship between TPG and FFR values, with r = 0.63 (p < 0.001). CONCLUSIONS The quantitative analysis of transmural perfusion gradients on high-resolution myocardial perfusion CMR accurately predicts hemodynamically significant CAD as defined by FFR. A TPG diagnostic threshold of 20% is as accurate as visual assessment. (J Am Coll Cardiol Img 2013;6: 600-9) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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